Surgical oncology

Whether surgical oncology constitutes a medical specialty per se is the topic of a heated debate. Today, some would agree that it is simply impossible for any one surgeon to be competent in the surgical management of all malignant disease. There are currently 19 surgical oncology fellowship training programs in the United States that have been approved by the Society of Surgical Oncology and this number is expect to grow.[2] While many general surgeons are actively involved in treating patients with malignant neoplasms, the designation of "surgical oncologist" is generally reserved for those surgeons who have completed one of the approved fellowship programs. However, this is a matter of semantics, as many surgeons who are thoroughly involved in treating cancer patients may consider themselves to be surgical oncologists.

Most often, surgical oncologist refers to a general surgical oncologist (a subspecialty of general surgery), but thoracic surgical oncologists, gynecologic oncologists and so forth can all be considered surgeons who specialize in treating cancer patients.

The importance of training surgeons who sub-specialize in cancer surgery lies in evidence, supported by a number of clinical trials,[3] that outcomes in surgical cancer care are positively associated to surgeon volume—i.e., the more cancer cases a surgeon treats, the more proficient he or she becomes, and his or her patients experience improved survival rates as a result. This is another controversial point, but it is generally accepted—even as common sense—that a surgeon who performs a given operation more often, will achieve superior results when compared with a surgeon who rarely performs the same procedure. This is particularly true of complex cancer resections such as pancreaticoduodenectomy (Whipple procedure) for pancreatic cancer, and gastrectomy with extended (D2) lymphadenectomy for gastric cancer. In the United States and Canada, fellowship trained surgical oncologists have among the longest training periods of any physicians/surgeons. A training period (clinical and research) of 6 to 8 years is typical and 8–10 years is not uncommon.

These are the most common types and forms of oncological surgery:[4]

• surgery to diagnose cancer
• surgery to stage cancer
• curative surgery

• radical surgery

• surgery to debulk cancer
• palliative surgery
• supportive surgery
• reconstructive surgery
• preventive (prophylactic) surgery.[5]

Newer surgical techniques are less invasive, use different types of surgical instruments, and lead to less pain and shorter recovery times. The most effective surgical oncology techniques are:

• laser surgery
• cryosurgery
• electrosurgery
• radiofrequency ablation
• mohs surgery
• laparoscopic surgery
• thoracoscopic surgery
• robotic surgery and other forms of surgery.[6]

Many publications in surgical oncology are also appearing. The majority are large reference textbooks that seemingly combine specialties that are not generally practiced by a single practitioner but cover the academic subject. A number of practical handbooks such as "surgical oncology" in the well read Oxford Handbooks series, have recently been published, perhaps alluding to the evolving practicality of this emerging discipline.

• European Society of Surgical Oncology
• Society of Surgical Oncology